腹主动脉腔内修复术栓塞单侧髂内动脉术后臀肌跛行危险因素及步行锻炼的效果分析

Risk factors and therapeutic effects of walking exercise for buttock claudication after endovascular aortic repair combined with internal iliac artery embolization

目的探索腹主动脉瘤腔内修复术(endovascular aortic repair,EVAR)联合髂内动脉栓塞术后患者出现臀肌跛行的危险因素,以及运动锻炼对臀肌跛行的治疗效果。方法回顾性分析2020年1月至2022年12月南京大学医学院附属鼓楼医院119例行EVAR联合髂内动脉栓塞术患者的临床资料。术后随访判断臀肌跛行相关情况,并结合患者情况和术前影像资料分析EVAR术后出现臀肌跛行的危险因素。鼓励2021年2月之后出现臀肌跛行的患者进行为期6个月的步行锻炼,通过与未进行步行锻炼的患者比较分析步行锻炼对臀肌跛行症状的治疗效果。结果47例(39.5%)患者术后出现臀肌跛行症状。多因素Logistic回归分析显示,髂内动脉合并附壁血栓(OR=2.244,95%CI=1.035~4.868,P=0.041)和髂内动脉远端分支数量<2支(OR=2.361,95%CI=1.060~5.258,P=0.035)是EVAR联合髂内动脉栓塞术后臀肌跛行的独立危险因素。完整参与步行锻炼和未参与步行锻炼的患者报告臀肌跛行症状好转的比例分别为52.9%和50.0%,差异无统计学意义(χ2=0.029,P=0.866);完整参与步行锻炼患者的恢复时间为(6.2±2.2)个月,显著短于未参与步行锻炼患者的(9.4±3.7)个月,差异有统计学意义(t=2.159,P=0.047)。结论髂内动脉合并血栓形成及髂内动脉远端分支数量不足2支是EVAR联合髂内动脉栓塞术后出现臀肌跛行的独立危险因素。规律的运动锻炼并不能改变臀肌跛行的治愈率,但能加快部分患者的恢复时间。

Objective To explore the risk factors for buttock claudication in abdominal aortic aneurysm patients after endovascular aortic repair(EVAR)combined with internal iliac artery embolization,and the therapeutic effect of exercise on buttock claudication.Methods The clinical data of 119 patients who underwent EVAR combined with internal iliac artery embolization in Affiliated Drum Tower Hospital,Medical School of Nanjing University from January 2020 to December 2022 were analyzed retrospectively.Postoperative follow-up was performed to determine the conditions related to buttock claudication,and the risk factors for buttock claudication after EVAR were analyzed based on the patient's condition and preoperative imaging data.Patients who developed buttock claudication after February 2021 were encouraged to undergo a 6-month walking exercise,and its therapeutic effect on buttock claudication was analyzed by comparing them with patients who did not perform walking exercises.Results Forty-seven patients(39.5%)developed buttock claudication after surgery.Multivariate Logistic regression analysis showed that preoperative thrombosis of the internal iliac artery(OR=2.244,95%CI=1.035-4.868,P=0.041)and the number of distal branches of internal iliac artery less than 2(OR=2.361,95%CI=1.060-5.258,P=0.035)were independent risk factors for buttock claudication after EVAR combined with internal iliac artery embolization.The proportion of patients who reported improvement in buttock claudication symptoms in patients who fully participated in walking exercise and those who did not participate in walking exercise was 52.9%and 50.0%,respectively,with no significant difference(χ2=0.029,P=0.866).The recovery time of patients who fully participated in walking exercise was 6.2±2.2 months,which was significantly shorter than that of patients without walking exercise(9.4±3.7 months),with a statistically significant difference(t=2.159,P=0.047).Conclusion The combination of thrombosis in the internal iliac artery and the number of distal branches of internal iliac artery less than 2 are independent risk factors for buttock claudication after EVAR combined with internal iliac artery embolization.Regular exercise training cannot change the cure rate of buttock claudication,but it can speed up the recovery time of some patients.